Do your students receive insurance coverage for more than two weeks?
Call for more information

Do you have an insurance utilization person?
Full time staff member

Is the program on any insurance panels?
Yes

State and/or National
CARF (Commission on Accreditation of Rehabilitation)
Joint Commission (JCAHO)
State License

Academic Accreditation
N/A

Religious Affiliation?
No

Please specify the type of religious affiliation
N/A

Minimum Age of Participants
12

Maximum Age of Participants
17

Can program support 18-year-olds if they enroll before 18?
Yes

Program can accept students with I-20 Visa?
N/A

Average Length of Stay (months)
2

Maximum Enrollment
6

Location of Program
Suburban

Dorm/Housing
Single Rooms with Private Baths
Single Rooms with Shared Baths
Doubles

How does the program prevent students from leaving (running) from the program
Students are Always in “Line-of-Sight” with staff

Does the program have more than one location for this particular program?
Yes

Family Involvement
HIGH: Family Expected on weekly calls (or more) & to attend all family workshops (weekly , monthly or quarterly)

Percentage of Aid to Adoptive Family Students
N/A

Percentage of Court Ordered Students
N/A

Percentage of Private Pay Students
N/A

Percentage of School Funded Students
N/A

Percentage of State Funded Students
N/A

Is there individual therapy?
Yes, part of the program cost

Number of individual therapy hours student receives on a difficult week?
N/A

Number of individual therapy hours student receives on typical week?
3

Percentage of licensed therapists?
> 50%

Therapist average case load
3

Percentage of full time therapists who have a private practice outside a program?
< 50%

Does the Clinical Director carry a case load?
No

Is there group therapy?
Yes

Average number of hours per week facilitated by licensed therapist
15

Average number of hours per week of group processing? (i.e. run by staff, interns, grad students, etc.)
0

Average number of formal family therapy hours per week (not social calls to teen)
2

Is Skype accessible for family therapy?
Yes

Are there Additional Professionals? (Select all that apply)
Licensed Practical Nurse
Psychiatrist
Other

Are there Medical rule outs
Yes

Possible Medical Rule Outs
Fire Starter
Call For more information

Is there a minimum BMI
N/A

Can Program accept insulin-dependent diabetics
N/A

Psychiatrist
On staff

Percentage of students on meds at enrollment
> 50%

If psychiatrist is available to students, what percentage of students change meds?
> 50%

Types of Therapy Offered
12 Steps Groups
Art Therapy(with certified art therapists)
Behavior Modification
Behavior Tech Trained staff & Therapists
Cognitive Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Dialectical Behavior Therapy (DBT) Skills
Equine Assisted or Therapeutic Horse Back
Expressive Art Therapy
Motivational Interviewing (MI)
Psychodynamic Therapy
Seeking Safety
Seven Challenges
Other

Does the program have a level/phase system?
Yes

If yes, are phases/levels tied to privileges?
Yes

Does program have a milieu-driven residential model? (Staff are trained in model)
Yes

If yes — select all that apply
Behavior Tech Trained Staff and Therapists
Other

Integrated Wellness
Art
Meditation
Yoga
Other

Does program use time out rooms?
No

Line staff to student ratio during awake hours
1:3

Does program run background checks on all staff?
Yes

Is there an educational requirement for staff?
Yes

If Yes, what is it?
Other

Average number of hours staff are trained before their first shift
40

Are night staff awake or asleep
Awake

What percentage of the line staff are full time employees?
All

Grades Served
Call for more information

Average student to teacher ratio
N/A

Teaching/Classroom
Other

Is the program able to implement IEP’s
N/A

Can Program handle a student who is more than two grade level’s behind in reading?
N/A

Academic Calendar
N/A

Can program support a student to complete a GED?
N/A

Can program support a student who wants vocational training?
N/A

Does the school have AP Classes or the ability to give or take a student to the AP Test?
N/A

Does the academic program have the ability to provide ACT or SAT Tutoring (on or off site)?
N/A

Does program have transition services for students?
Yes

If Yes, select all options that apply to your program
Other

Are there additional fees that apply to transitional options?
No

Percentage of families that participate in various transition programming?
Call for more Information

Scheduled or rolling admissions?
Rolling admissions

Is there an enrollment fee/outfitting fee/payment in advance?
N/A

If applicable, is the last month’s fees due at enrollment?
N/A

Cost per month/workshop/programming (in USD)
N/A

Percentage of clients who return home, or to a more traditional setting (like transitions to college or gap year, boarding school, etc.)
> 50%

Does a student have to sign themself into the program?
No

Link to Weekly or Daily Schedule
N/A

For licensed programs, but state or under 18, please select Incidents required to be reported to the state:
N/A

What is the typical amount of time a family should expect before hearing about an major incident?
N/A

What is the average number of clients you see per year?
N/A

Professional Associations/Affiliations
N/A

Payment Type
Insurance (see above for specifics on insurance)
Private | Self Pay
Call for more information

Has the program previously been part of an evidence-based study?
Call for more information

Is the program presently part of an evidence-based study?
N/A

Link to the study that the organization is part of
N/A

Type of Family Therapy/Work Offered
1 hour max call with therapist per week
Family Handbook
Family process facilitated by another therapist
Flexible length of call with therapist per week
Parents Visit as Needed

Family involvement
HIGH: Family Expected on weekly calls (or more) & to attend all family workshops (weekly , monthly or quarterly)

Who completes the psychological evaluation?
Multidisciplinary Team

Minimum length of stay
N/A

Does the student receive a neuropsychological evaluation?
N/A

Type Of Programming For Students
Clinically-driven programming (addresses individual life, living, social and academic needs)
Call for more information

Typical Student
ADHD/ADD
Clinically Complex (possible behavior, genetic, students “who are puzzles”)
Mood Deregulation &/or Anxiety
Other

Minimum IQ
N/A

Interview Requirements for Applicants
Call for More Information

Additional Therapy
N/A

Therapist Case Load at Peak Season
< 8

Percentage of licensed therapists?
> 50%

Average number of days/week therapist is in the field
5

Number of Individual Sessions with Therapist
3

Integrated Wellness Support
Art
Breathing Techniques/Breath Work
Meditation
Yoga
Other

Do clinical assistants work with lead therapists?
Yes

Percentage of full time therapists who have a private practice outside of wilderness?
< 50%

Do any of the therapists operate more than one group at peak season?
Yes

What percentage of participants receive psychological evaluations?
< 50%

Does program receive a fee for evaluation or referral?
No

Additional levels of care offered by facility
N/A

Types of eating disorder care provided
N/A

Specialized Programming
N/A

Is program focused on full recovery?
N/A

Housing
N/A

Community Service Requirement
N/A

Random Drug Testing
N/A

Transportation Options
N/A

Support Services
N/A

House/Community Meetings
N/A

Are participants required to do chores in the house/community?
N/A

12 Step Meetings on Location
N/A

Type of Students
N/A

Computer Access
Call for more information

Cell Phones
Not Allowed

Academic Options
Call for more information

School Name (if applicable)
N/A

School Website (if applicable)
N/A

Types of Workshops Offered
N/A

Accommodations
N/A

Use of Personal Vehicle
N/A

Use of Electronics
N/A

Location of Workshop
N/A

Average Length of Workshop
N/A

Professional Associations/Affiliations
N/A